Income Shocks, Maternal Nutrition and Infant Health

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A recent study (PDF) by Alfredo Burlando of the University of Oregon on income shocks, maternal nutrition and infant health was highlighted on the World Bank’s Development Impact blog, an excellent resource for people interested in impact evaluation in economic development and global health. The paper uses the 2008 blackout in Zanzibar to determine how instable earnings may effect birth outcomes. The author uses differences in reliance on electricity for income to create a natural experiment between mothers whose incomes would decrease and those for whom it would remain constant and finds “the reduction in weights is correlated with measures of maternal exposure to the blackout.”

Burlando continues:

I also use records from a government hospital to show that those children who were conceived during or shortly after, those exposed during the Örst six weeks of gestation, and those exposed in the fifth month of gestation had lower birth weights on average than expected. Moreover, among those exposed early, there was a marked increase in probability of Low Birth Weight…While several explanations exist that might explain the drop in average weights, the data is most consistent with a reduction in caloric intake by the a§ected expectant mothers. Such a drop might be explained by a blackout-related income shock. I show that birth weights were lowest among those who were born from parents residing in wards with a significant concentration of workers in electrified sectors. Moreover, there is some evidence that among the cohort of children exposed in the fifth month of pregnancy, the driving factor to lower weights was not the income shock, but maternal stress.

Jed Friedman of the World Bank notes a few key takeaways from the study, but the first is most critical for how we approach maternal and infant health interventions:

The findings suggest that women who were known to be pregnant at the time of the black out, i.e. those who were visibly pregnant, received insurance from the shock where as women who did not realize they were yet pregnant (or who had conceived during the blackout) did not receive the same protection…These findings highlight the importance of behavioral responses and that people in the face of a crisis can be resilient when they are armed with relevant knowledge – households with women who knew they were pregnant apparently prioritized maternal nutrition. It also underscores the obvious point that any protective program that targets pregnant women faces the challenge of improving the informational barriers that prevent early pregnancy awareness.

The findings indicate that push towards increasing maternal knowledge of the impacts of nutrition during pregnancy on the health of their child can lead to better outcomes. Women (and families and communities) who are equipped with that knowledge seemingly put it to work during the Zanzibar blackout to ensure that knowingly pregnant women received the food they needed.